Hydromorphone as a Migraine abortive instead of Demerol?

Full Question:

I usually use injectable Demerol to abort migraines that are not responding to Triptans. But Demerol is back ordered until October. Can hydromorphone be used instead? Or is there another injectable narcotic that will work? Gin.

Full Answer:

Dear Gin;

Using medications such as Demerol as rescue medications when triptans fail is a common practice. Since you said you use it to "abort Migraine," it should be pointed out, however, that Demerol cannot abort a Migraine. It simply lacks the actions to do so. It can mask the pain of a Migraine for a few hours, and perhaps your Migraines end during those hours or you're able to get into a deep enough sleep for the sleep to abort them, but Demerol isn't an abortive medication.

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As to your question about whether other injectable opioids will work as well for you, there's no simple answer to that question because it depends upon how your body responds to each of them. As with Demerol, none of the other opioids can abort a Migraine attack either, but they are sometimes used as rescue medications.

We prefer to use an NSAID such a ketorolac (Toradol) alone with an antinausea medication such as metoclopromide (Reglan) for rescue and leave opioids as medications of last resort since use of opioids increases the risk of episodic Migraine transforming to chronic Migraine, and if the patient already has chronic Migraine, makes it more difficult to reduce it back to episodic. In short, opioids aren't good choices for Migraine treatment, so we reserve them until we've exhausted other options.

Dr. Krusz is a recognized expert in the fields of headache and Migraine treatment and pain treatment. Each week, he and Lead Expert Teri Robert, team up to answer your questions about headaches and Migraines. You can read more about Dr. Krusz or more about Teri Robert.

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